What does the medical insurance policy give?
A medical insurance policy is a document,which certifies the concluded contract on medical insurance of a citizen of the Russian Federation. Medical insurance can be mandatory (MHI) and voluntary (VHI). What is the difference between OMS and LCA? The compulsory insurance contract is concluded between two legal entities - an organization, an institution, an enterprise and an insurance company. With OMS, deductions are made to the CHI fund, and the insurer company plays the role of an intermediary. In the case of issuance of VHI, in addition to mandatory deductions to the MHIF fund, contributions remain in the insurance company. VHI can be obtained by any person independently or through a firm that pays these contributions from the wage fund.
The medical insurance policy of compulsory insurance contains the following data:
- PIN-code, series, number and name of the insurance company;
- FULL NAME. insured person, date of birth, place of work and home address;
- number of the concluded contract, its validity;
- transfer of polyclinics, dentistry, KVD, consultations, to which a citizen is attached.
This health insurance policy must beis necessarily certified by the seal of the organization and the signature of the head, and also contain the signature of the citizen. On the back of the policy, as a rule, information is indicated:
- telephone numbers of the insurer;
- its postal and e-mail addresses;
- telephone reference pharmacies, hotline, claims and the department for the protection of the insured.
Where to get an insurance medical insurance policy shoulddecide the person himself. You can get a medical policy through work (usually policies are made for all employees centrally in one of the insurance companies) or independently, choosing a more reliable insurance company. The following services are included in the individual policy:
- outpatient care;
- inpatient care (in hospitals);
- home care;
- diagnostics (ultrasound, clinical examination);
- dental care (all services except prosthetics and cosmetology).
Under the LCA, there are programs for adults and children.
Non-working population (pensioners, unemployed,children) also have the right to be insured according to the CHI system. An insurance medical policy for these categories of citizens previously received in one insurance company, and now they can apply to any company.
The rights of citizens under CHI and duties in accordance with Art. 16 of Law No. 326
A citizen who has received an insurance medical policy has the following rights:
- in the event of an insured event, receive medical care free of charge in the Russian Federation;
- choose a medical institution, a doctor, an insurance company, submitting an application of the appropriate sample;
- on the protection of personal data passing through electronic processing;
- to compensation for damage caused by poor performance of medical duties or their non-performance.
Obligations of citizens:
- present an insurance medical policy in case of contacting a doctor for help (except for emergency cases);
- when changing the insurance company to file an application independently or through a representative;
- within 1 month to notify the insurer about the change of the name. and place of residence;
- when you change your place of residence, insure yourself within a month.
With all medical insurance innovations can be found by reading the law FZ-326 (2010).